Behind the lines of Britain’s COVID war

By Alan Cowell

The numbers may be trending downward, but the battle is no less intense. In the land of Winston Churchill, it is likened sometimes to war, the COVID war.

In the latest phase of Britain’s splintered campaign against the coronavirus, Prime Minister Boris Johnson last week laid out a long glide path for England’s gradual reopening from lockdown, from March to June.

But despite a speedy vaccine rollout, the schedule for changes was decidedly protracted — and declared reversible — for good reason.

After almost a year of mixed messages, COVID still divides the land between those who know and dread its fearsome reach, and those seduced by unlikely promises and invented deadlines of redemption.

The disease’s effect has been witnessed most readily in half-empty streets, shuttered shops and missed pints. Its shadow world of suffering remains largely cloistered in cramped intensive care wards, teeming with patients, where doctors and nurses work out of sight to the brink of despair.

It is through their heroism that the toll is not worse than it is already — more than 120,000 dead. The images sometimes evoke those of combat triage units amid the swirl of battle, with noise and chaos and bleeping monitors and medics tightly enfolded in protective garb, a spectral army thronging spaces overfilled with the most threatened of patients.

“One of my biggest feelings in the second wave has been anger at how many people are blatantly ignoring the rules and not really thinking about what they are doing out and about,” said Susan Jain, a specialist in anesthesia and intensive therapy who works with a team of doctors and nurses in the Intensive Care Unit at the Homerton hospital in East London.

“I want people to know how awful it is, how much a threat this is to all of us,” she said.

The British government casts its fight in superlatives: the fastest authorization of vaccines, the speediest rollout of inoculations. But there is another, more macabre marker: a higher per capita death toll than any other large country in the world.

It finally took the emergence of a much more transmissible variant of the virus in the county of Kent in December to galvanize the country and its government. Last month, Sharon Peacock, head of Britain’s genetic surveillance program, said the variant had “swept the country,” and “it’s going to sweep the world in all probability.”

The intensive care unit where Jain works had to expand from 10 patients to 30, nearly all of them on ventilators. “We are very packed in our particular unit,” she said. “It isn’t quite as bad as ‘M.A.S.H.,’ but that’s what comes to mind.”

By mid-January COVID fatalities were soaring, along with hospitalization and infection rates. On Jan. 20, Britain’s daily tally of death peaked at 1,820 patients who perished within 28 days of testing positive.

The fatalities have been especially high among some ethnic minorities.

“Our workload has increased about tenfold,” said Idris Patel, founder and chief executive of the Muslim Patel Burial Trust/Supporting Humanity, a charitable group. “We used to bury two to three a week in summer, four to five in winter. Now it’s six a day.”

Normally, funeral rites begin in a mosque with an imam reciting the Janaza, the Islamic funeral prayer. But these days, Kafil Ahmed, who runs the Al Birr Islamic Trust Funeral Service in Greenwich, southeast London, sometimes performs the rites himself, graveside.

The government’s vaccination campaign has largely been welcomed as a glimmer of hope and is being expanded.

With the onslaught of disease seeming to be in retreat, fear of infection is being supplanted by an almost palpable yearning for the counter-vision of a Shangri-La where pints are pulled in sunlit pubs, children gambol in brightly painted classrooms and airlines fly to faraway beaches.

Although Johnson’s latest “road map” out of the lockdown was depicted as cautious by the government, the news made Mike Padgham, managing director of St. Cecilia’s care home in the seaside resort of Scarborough, northeast England, “a little nervous.”

In the first wave, care home residents suffered disproportionate casualties as hospitals moved aging patients into care facilities to free up beds for COVID patients. Up to one-third of all deaths in 2020 occurred in facilities catering to older people, many of them suffering from dementia.

In the current wave, fewer patients recovering from COVID are being taken to care homes, such as Padgham’s, where they have a dedicated floor. The risks remain steep.

Under the government’s new changes — set to take effect March 8 — his charges would be allowed visits by a family member under strict conditions. No hugs. No kisses. But hand-holding is OK.

But, Padgham worries, there could always be “the odd person who would give their mum or dad a hug or a kiss.”

An infection, he said, would “spread like wildfire” through the 110 residents of St. Cecilia’s. Most have received only the first of the prescribed two doses of vaccine, adding to the trepidation.

“I don’t think the government has thought it through as clearly as they ought to,” he said. “We have to take the brakes off very gently.” In an article he wrote recently, he measured the COVID war against Churchillian rhetoric midway through World War II “warning that the war wasn’t over yet.”

For others, too, there is an uneasy comparison with the closing phases of distant military conflicts in war-weary lands.

Somewhere, out there, beyond the immediate palisade, the fighting continues. But it has been overtaken by a yearning for normalcy.

“I think I feel quite cynical about it,” Jain said. “I can’t honestly see a time when we’ll be free to roam around, go to cafes, the theater, go to concerts, be all packed in like sardines on the Tube.

“You’d have to get the whole world vaccinated to get back to that — and make sure the vaccine is effective.”

For now, she is a servant to the strange rituals of the pandemic, no less tedious for their familiarity and urgency. The “donning and doffing” of personal protection equipment has assumed an overweening importance in containing infection, said Jain, who cares for two children at home and her aging parents and a nearby aunt.

“At the end of the day, I take a shower at work, and as soon as I come home I won’t let the children come near me until I have showered again,” she said. “How do you know what you bring back?

“The whole time since it started, especially at the beginning, I was convinced I was going to get it,” she said. “I thought it was inevitable.”

She has not.

Inevitably, those on the front lines — funeral workers, doctors and nurses — are often most exposed. So are their kin.

In December, Ahmed, of Al Birr Islamic Trust Funeral Service, said his younger brother, Zia Ahmed, had sickened. When the ambulance did not arrive, he bundled him up himself and drove him to the emergency room.

“And that’s it,” he said, “from there on they said that he had COVID. So I got myself tested, and I was positive, too.”

His wife, Nasim, who had lost her mother and a brother-in-law to COVID, also tested positive. Neither of them was hospitalized. But it was “very hard,” Kafil Ahmed said. “It breaks you from inside.”

On Feb. 19, Ahmed said, hospital authorities told him that, “if my younger brother survives the weekend, it will be a miracle.” On Feb. 21, he learned that his brother had died. There had been no miracle.

“COVID,” he said, “has turned everything upside down.”

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